Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 23519 | TN |
N | 2080P0204X | Pediatric Emergency Doctor | 23519 | TN |
Y | 363L00000X | Nurse Practitioner | 23519 | TN |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 23519 | TN |
NPI | 1649783705 |
---|---|
Provider Name | Jordan Brush Mccreary |
First Address | Knoxville, TN 37917-2957 |
Second Address | Knoxville, TN 37916-2301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2017 |
Last Update Date | 17/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2017025275 | ANCC (01) | |
23519 | STATE TENNESSEE APRN LICENSE (01) | TN |
MT4675370 | DEA (01) |